Provider Demographics
NPI:1982762142
Name:HACKETTSTOWN RADIOLOGY ASSOCIATES
Entity type:Organization
Organization Name:HACKETTSTOWN RADIOLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAK KAN
Authorized Official - Middle Name:ALBERT
Authorized Official - Last Name:LO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-850-6842
Mailing Address - Street 1:PO BOX 655
Mailing Address - Street 2:
Mailing Address - City:HACKETTSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07840
Mailing Address - Country:US
Mailing Address - Phone:908-850-1319
Mailing Address - Fax:908-850-9174
Practice Address - Street 1:651 WILLOW GROVE ST
Practice Address - Street 2:HACKETTSTOWN REGIONAL MEDICAL CENTER
Practice Address - City:HACKETTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07840
Practice Address - Country:US
Practice Address - Phone:908-852-5100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3041701Medicaid
NJ3041701Medicaid
=========OtherHORIZON BCBS